I N S I D E

2 0 2 0 SUMMER

Continuing the Care

Keeping Patients Healthy

Before... and Waiting

Caring Never Stops

Continues on the next page...

We have all witnessed and experienced many life-altering moments over the past few months. There have been moments of significant change, like when we left our offices and began working from home. There have been moments of heartbreak when missions and surgeries were abruptly cancelled; of innovation and persistence like we’ve seen in Nicaragua and many other countries where we work; of solidarity when Operation Smile donated our personal protective supplies to local hospitals and healthcare systems so they’d be prepared to fight the pandemic; of necessary compassion when we re-focused portions of our

work to ensure the children waiting for surgery, and those recovering, had the proper nutrition to survive… and indeed, thrive.

Our COVID-19 three-tiered response is designed to ensure the children, families and communities we serve are safe, healthy, and receive the optimal care we can safely deliver.

Tier 1: Pandemic Emergency Response Action PlanMuch of our expertise is geared towards operating in low-resource places, and this pandemic has amplified the need for leveraging this

experience and expertise on a global scale. We are seeing first-hand how local health systems around the world are stretched beyond their limits. This Smile Report contains stories about the immediate actions taken in many of the countries where we work.

Tier 2: Secondary Response PlanOur Secondary Response Plan involves looking at ways our existing comprehensive care programs can be broadened while we simultaneously build scenarios to carefully re-open some of our 31 local cleft care centres. For the foreseeable future,

Summer 2020 Smile Report 1

Continued from cover...

much of the care we provide will be delivered locally, and by local volunteers, making our care centres essential hubs in coordinating and delivering surgery and much of our care.

Tier 3: Post-pandemic Surgical Response

With approximately 300 children born with cleft conditions being added to the waiting list everyday, we’ve wasted no time thinking about what a “return to surgery” will look like. We’ve concluded this: How we deliver our surgical missions in the future will look different than before. Evaluating and screening children will look different. And, it will very likely cost more to conduct surgeries and provide ongoing care than it did before COVID-19.

The pandemic is forcing rapid change to happen, and we’re determined to make sure that change positively impacts the children needing cleft surgery, their families and communities, and the local health systems which serve them. You, and every Canadian partner will be integral in supporting our efforts to emerge from the pandemic with stronger and healthier patients, families, communities and healthcare systems in the countries we currently serve. Thank you for standing with these children.

Best, Always!

Mark Climie-Elliott, CFRE CEO and Chief Smile Officer

BEFORE… AND WAITING Nine-year old Levis is a young boy full of energy who loves playing soccer.He and his mother Angela live in a village on the edge of a large national nature reserve in Nicaragua. The Caribbean Sea is 75km due east. Some 237km west is the capital city Managua, and the Dr. Fernando Vélez Paiz Hospital, site of our local surgical mission that took place in mid-March.

Getting his new smile was a dream for Levis and his family. Surgery would improve Levis’s self-esteem since he has been a victim of bullying by his classmates. “When he arrives from school he is distressed because his friends call him ñajo. My child

cries constantly,” Angela says. Levis’s parents were eager for this opportunity and to see the end result. Angela said Levis told her, with a big smile, “Don’t worry mommy, when I go home I will be different and I will be able to go to class calmly.”

On Thursday March 19, the day before his surgery, Levis’s dreams were put on hold because the first case of COVID-19 was reported in Nicaragua. The decision was made to cancel all surgeries on the final day to protect the health and safety of everyone involved in the mission.

Levis joined the over 10,000 patients scheduled for surgery and dental care before June 30, who will not receive new smiles because of suspended missions. Unfortunately, that number only grows with each passing day.

Levis, age 9, from Nicaragua

2 Summer 2020 Smile Report

KEEPING PATIENTS HEALTHY Nutrition is an important part of comprehensive cleft care.It’s a fact that many of our patients are malnourished or are unable to properly feed because of their cleft conditions.

With missions postponed, surgeries suspended and most care centres closed at the moment, taking care of patients before and after surgery, and supporting patients’ families, is more important than ever. Many struggle to make a living and keep their families fed. Now, their livelihoods are even more at risk because of the pandemic.

We are working hard with our program countries to ensure patients are getting the proper nutrition they need to survive and stay healthy.

Operation Smile Madagascar has been supplying families with Ready to Use Therapeutic Food (RUTF - a peanut-based nutrition supplement), formulas, meal supplements and food baskets through their, now expanded, nutrition program called Extra S’Mile. These supplies ensure young children get the nutrients they need to survive during their lockdown period.

We’re also monitoring the health of our patients through direct phone calls, community volunteers and community health facilities where nutritional supplements and food baskets are being distributed. Our patient advocates and community volunteers are also helping us deliver these necessities to our patients and their families in remote locations. If families cannot come to us, or community distribution points, we are

finding ways to safely go to them.

In Honduras, we have supported nearly 170 patient families around the country with food and therapeutic formula.

We leveraged our local partnership with the Inga Health Foundation in India and the local governments in Mumbai and Durgapur to distribute basic food and hygiene items to 700 patient families who were being hit hardest by that country’s nationwide lockdown.

Keeping our patients and their families fed and nourished helps ensure that once surgical programs resume, they will be healthy enough to receive surgery.

Winter 2020 Smile Report 3Summer 2020 Smile Report 3

NEVER TOO EARLY

With a lasting gift in their wills, this young couple is helping children in need of safe surgery long into the future. “The very first thing my daughter’s cleft surgeon said to me was ‘you didn’t do anything wrong,’” Angie remembers. Her daughter Sophie’s cleft lip was identified during a prenatal ultrasound, and she was referred to a specialist for care.

Angie began educating herself about cleft conditions and discovered her experience in Canada was not shared by parents in many low- and middle-income countries. She learned of Operation Smile’s work to increase access to safe surgery through the power of volunteers, and the life-threatening dangers facing children with untreated cleft conditions. Angie and her husband Adam became Operation Smile Canada donors.

Incredibly, the surgeon who performed Sophie’s surgery was Dr. David Fisher, a world-renowned cleft expert and Operation Smile veteran who has volunteered on many medical missions, from Cambodia to Ethiopia. He is the inventor of the “Fisher technique”, a surgical approach to cleft repair used by surgeons around the world, including many of his fellow Operation Smile volunteers.

When Angie and Adam joined a local church, they were happily surprised to meet a family with a teenage daughter, Nicole, who had been born with a cleft palate. Sharing a special bond, the families quickly became close. Nicole now babysits for the family, affectionately calling Sophie her ‘little buddy.’

Shortly after their second daughter was born, Angie and Adam updated their wills. Together they decided to include a charitable bequest to Operation Smile Canada in both wills.

“Yes, it’s very important to provide for our children, of course, but there’s still room to include charity in our estate planning,” she explains. “We believe that these families should have access to doctors and medical care after we’re no longer here.”

Angie continues: “Our choice came from our wish to do more. Not being medical professionals who could volunteer ourselves, making a gift to Operation Smile Canada in our wills made a lot of sense. It’s never too early to plan ahead.”

While access to safe cleft surgery and the stigma around cleft conditions has improved over the past 40 years, Angie believes we have much further to go. She hopes that this progress will continue, dreaming of a day where surgical care will be available to all who need it.

We proudly welcomed Angie and Adam into our Forever Smiles Club, a special group to honour supporters who make a lasting gift, such as through wills, life insurance policies and retirement accounts.

To learn more about how you can make a lasting gift, or to be welcomed as a member of the Forever Smiles Club, you can reach out to Ken Butland 1.844.376.4530, ext. 109, or at ken.butland@operationsmile.org.

Forever Smiles Club members Angie and Adam from Ontario

4 Summer 2020 Smile Report

Nina Hardcastle, Candace Mielnichuk, Holly Leung, and Helen Wagner in Oujda, Morocco, March 2020

Jordan, 6-months old, visits the Managua Care Centre. Photo: Margherita Mirabella ABOVE AND BEYOND

Selfless and inspiring are just two words to describe Candace Mielnichuk, a dedicated Operation Smile medical volunteer based in Calgary. Fearless would be another. “I love being a nurse. It’s my calling. It’s what I’m meant to do,” says Candace.

In early May, Candace volunteered with an organization to provide disaster relief in Cremona, Italy, which at the time was one of the hardest hit areas by COVID-19 in Europe. “It was pretty surreal,” she says of her three weeks spent in a temporary respiratory care unit on the grounds of a local hospital.

Just a few short weeks before going to Italy and in the shadow of the unfolding pandemic, Candace had volunteered at Operation Smile’s all-women mission in Oujda, Morocco, part of a four-person Canadian contingent. Volunteer Helen Wagner was in Egypt the previous week, and stayed in the region to fill a last-minute need at the mission. “Thankfully, we were able to complete the full five days of surgery we had planned.” This special mission provided 129 children with new smiles and inspired the next generation of women in medicine. “It’s an absolute honour to be part of these teams that go around the world and change children’s lives,” she shared. Thank you team for your selfless dedication to helping others. You are an inspiration to us all.

STAYING CONNECTED TO PATIENTSContinuing to care for patients was top of mind for the team at Operation Smile Nicaragua as the world began to dramatically change. The cancellation of surgeries and the temporary closing of the care centre itself left many children and families feeling anxious. It became immediately clear to volunteers and staff that it was vitally important to find ways to connect with and support their patients and families through this difficult time

Very quickly, pre- and post-operative care provided in the centre was transitioned to being delivered virtually. Pediatric and nutrition consultations are being done online and over the phone in order to keep babies healthy and gaining weight. Psychologists are able to provide support for children and their families who have concerns and worries. And virtual speech therapy is allowing care to continue for many of the 1,800 patients at the centre.

Staff are able to connect with parents of newborn babies and offer support and advice, especially about feeding. Newborns with cleft often have a hard time feeding and proper nutrition is a vital part in ensuring their continued health. Malnutrition is one of the top reasons a child’s surgery gets postponed. Providing food kits is essential to keeping babies healthy and ready for surgery once it’s safe to be operating again.

Surprisingly, many patients and families feel more supported than before. Attending in-person sessions and consultations was limited by their ability to travel - many people live far away from the care centre. But now, they’re able to have it as often as they need, even weekly!

The care centre has been able to reach 400-500 patients since the end of March. Video calls, phone calls, and digital platforms like WhatsApp are being used to provide patients and their parents with videos, games and exercises that they can do together. With parents and kids spending more time together, parents are becoming teachers and have become more engaged with their child’s therapy and progress. These virtual sessions have proven to be an incredibly useful resource for our patient families.

Winter 2020 Smile Report 5Summer 2020 Smile Report 5

CONTINUING THE CARE Supporting patients at a distance, where we can and as best we can, is imperative. It’s also driving innovation.

Two care centres led the way in early April by providing speech therapy and psychosocial support with cellphones and over the internet.

In Colombia, speech therapist Angie Agudelo (pictured) uploads videos to Operation Smile Colombia’s YouTube channel. She shares ideas about activities that kids can do while staying at home, along with specific techniques for children to continue to develop their speech after surgery.

Not wanting children to lose the progress they’ve made in their one-on-one speech therapy sessions, Scarlette Gomez, a speech therapist in Nicaragua, is using Facebook Live to help her patients. “I’ve always tried to

portray that therapy is something you can do at home, having a fun time and learning as much as we can! I’ve been working with most of these patients for more than two years now and it’s really easy to just forget the progress if you don’t practice,” Scarlette says.

If patients only have a cell phone, but with no video, a session takes a bit longer but is no less effective. For children under 8 years old, Scarlette

says she “talks them through it and I let the mom tell me what the patient is doing. And if they are older, I talk to them directly and I just give instructions and depending on how it sounds, I give them feedback.”

These speech therapy sessions are effective because “the patients have their parents at home making sure they do the exercises and now I’m able to send them even more interactive materials and activities.”

ELMEHDI Nothing had prepared Soumia for the shock she felt when her son Elmehdi was born with a cleft lip. “When he was born, I was scared,” Soumia said. “I didn’t know what a cleft lip was. I’d never heard of it.” But shock soon turned to determination as Soumia sought help for her son.

Soumia heard about Operation Smile Morocco’s medical mission in Oujda through social media. Seeing help in sight, she pressed on and never let anything prevent Elmehdi from getting the care he needed. “I live in Tafoughalt. It took me two hours to get here. I took the bus. I’m tired, but I want my baby to get help,” Soumia said.

Eight-month old Elmehdi was cheerful as he and his family completed each stage of the screening process. After Elmehdi passed his comprehensive health evaluation and was selected to receive surgery, Soumia expressed her relief and appreciation to the volunteers involved with this mission and every other Operation Smile mission.

“Everyone is so nice. I’m so grateful to Operation Smile. I’m happy and Elmehdi is happy,” she said.

Elmehdi, 8 months old, Morocco. Photo: Jasmin Shah

6 Summer 2020 Smile Report

Everything seems to have changed since the last Smile Report in mid-March. We know the current reality, and an uncertain future, is challenging to deal with. Yet every day, Kathy and I and the entire global team roll up our sleeves and re-commit to our work to helping the thousands of children who have been forced to wait for cleft surgery and post-surgery care. And it’s truly heartbreaking to think that with each passing day, that wait list gets longer and longer.

The last few months have given all of us at Operation Smile the challenge and opportunity to re-group in the face of adversity. By necessity, it has allowed us to re-think how we deliver pre- and post-operative care along with training and education, in new ways. More fundamentally, the pandemic has given us an opportunity to examine and re-imagine our programs for a world where needs will be greater and viable solutions costlier.

While COVID-19 has changed so much for so many, it has not changed what Operation

Smile was founded on and built on and that’s our promise, and our responsibility, to the children and their families: that no child will be left behind. As long as children are waiting – we stand ready to help. Thank you for standing with us.

As a valued partner in our work, I hope you’ll reflect on the powerful contribution you make to the lives of children waiting for surgery. Your thoughts, prayers and well wishes for our children and volunteers are appreciated and motivate us all to want nothing more than to bring new smiles to deserving children around the world.

Stay safe and be well.

Dr. Bill and Kathy Magee, Co-Founders, Operation Smile.

The longest day of the year truly turned out to be the Longest Day of SMILES thanks to everyone who joined the SMILE movement in support of Operation Smile Canada. Together, with the help of a generous donor who matched all gifts up to $50,000 in June, and our partner at Invisalign doubling their effort, we

exceeded our goal of delivering 2,020 new smiles to children around the world. We couldn’t have done this without your ongoing support and partnership with us throughout the year. We are filled with gratitude and the children we serve can’t thank you enough. THANK YOU!

A MESSAGE FROM BILL AND KATHY

PROUDLY SUPPORTED BY:

Winter 2020 Smile Report 7Summer 2020 Smile Report 7

WE’RE HERE TO SERVE YOU We’re here to serve you. From making a donation over the phone, updating your contact information, changing your monthly donor credit card or banking information, to discussing the impact of your gift or how to have lasting impact with a gift made through your will, we’re always so pleased to hear from you.

Contact us by phone:

Toll-free: 1.844.376.4530 or Local: 647.696.0600

By email: ca-supporters@operationsmile.org

By mail or in person:

375 University Ave., Suite 204 Toronto, ON M5G 2J5

Visit our website: www.operationsmile.ca

/operationsmilecanada @operationsmilecanada

Thanks to you, our caring never stops.

ANOTHER WAY TO GIVE

You have another way to help deliver smiles to children around the world who are waiting for cleft surgery by donating your Aeroplan points to

Operation Smile Canada.

We have a page on Aeroplan’s website for you to donate your Aeroplan points.

These points will be used towards flights for our cause. Aeroplan will

match 10% of the points you donate for an even bigger donation and

impact!

If you’re an Aeroplan member, please consider donating some of your points

to help send our medical volunteers on life-changing missions (of course,

only when it’s safe to do so.)

To donate, visit www.operationsmile.ca/aeroplan

A CANADIAN FIRSTThe Operation Smile Student Club at Western University in London, ON hosted the first Canadian U-Lead conference in early March.

The free, full-day symposium focused on global medical leadership and innovation. Child Life Specialist and Operation Smile medical volunteer Morgan Livingstone (pictured above) opened the day with a presentation on innovations in the child life field and her research. A series of breakout sessions included a presentation by Dr. Elysee Nouvet on factors influencing perceptions of short-term medical missions. There was also a discussion on empowering under-served communities through the provision of health-care by the Global Brigades association at Western University. The day ended with more hands-on workshops like a suturing seminar and a session about dental anatomy involving real human teeth! We are so proud of our student leaders for putting on such a successful inaugural U-Lead conference. Congratulations!

Students practice their suturing skills on bananas during a workshop.

8 Summer 2020 Smile Report